Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Conditioning Regimens

Safe administration of oral BU twice daily during conditioning for stem cell transplantation in a paediatric population: a comparative study between the standard 4-dose and a 2-dose regimen

Abstract

We compared outcome and toxicity in two paediatric groups undergoing SCT and treated with busulphan (BU) by the oral route of administration. One group receiving the standard dose of 1 mg/kg q.i.d. for a total of 16 doses was compared with age- and disease-matched patients receiving 2 mg/kg of BU b.i.d. for a total of eight doses. Seventy-two patients from two Swedish paediatric transplantation centres were included; one centre used a standard q.i.d. administration (n=37) and the second centre used a b.i.d. administration setting (n=35). Our primary objective was to determine the incidence of veno-occlusive disease (VOD), graft-versus-host disease (GVHD), relapse frequency and transplant-related mortality in both cohorts. A total of 17 autologous and 55 allogeneic transplantations was performed for malignant (n=47) and non-malignant (n=25) diseases in the two centres during the period 1990–2005. No significant difference in the incidence of VOD, graft rejection, GVHD, relapse rate or overall survival was observed between the two centres. The clinical outcome of SCT for paediatric patients conditioned with oral BU at a dose of 2 mg/kg for eight doses is comparable to that found for children conditioned using the standard regimen given 1 mg/kg q.i.d. for 16 doses.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Hassan M, Ehrsson H . Urinary metabolites of busulfan in the rat. Drug Metab Dispos 1987; 15: 399–402.

    CAS  PubMed  Google Scholar 

  2. Srivastava A, Poonkuzhali B, Shaji RV, George B, Mathews V, Chandy M et al. Glutathione S-transferase M1 polymorphism: a risk factor for hepatic venoocclussive disease in bone marrow transplantation. Blood 2004; 104: 1574–1577.

    Article  CAS  PubMed  Google Scholar 

  3. Kusama M, Kubota T, Matsukura Y, Matsuno K, Ogawa S, Kanda Y et al. Influence of glutathione S-transferase A1 polymorphism on the pharmacokinetics of busulfan. Clin Chim Acta 2006; 368: 93–98.

    Article  CAS  PubMed  Google Scholar 

  4. Hassan M, Ljungman P, Bolme P, Ringdèn O, Syrucková Z, Békàssy A et al. Busulfan bioavaliability. Blood 1994; 84: 2144–2150.

    CAS  PubMed  Google Scholar 

  5. Bullock JM, Smith PF, Booker BM, Loughner J, Capozzi D, McCarthy Jr PL et al. Development of a pharmacokinetic and Bayesian optimal sampling model for individualization of oral busulfan in hematopoietic stem cell transplantation. Ther Drug Monit 2006; 28: 62–66.

    Article  CAS  PubMed  Google Scholar 

  6. McCune JS, Gibbs JP, Slattery JT . Plasma concentration monitoring of busulfan: does it improve clinical outcome? Clin Pharmacokinet 2000; 39: 155–165.

    Article  CAS  PubMed  Google Scholar 

  7. Bolinger AM, Zangwill AB, Slattery JT, Risler LJ, Sultan DH, Glidden DV et al. Target dose adjustment of busulfan in pediatric patients undergoing bone marrow transplantation. Bone Marrow Transplant 2001; 28: 1013–1018.

    Article  CAS  PubMed  Google Scholar 

  8. Sandström M, Karlsson MO, Ljungman P, Hassan Z, Jonsson EN, Nilsson C et al. Population pharmacokinetic analysis resulting in a tool for dose individualization of busulphan in bone marrow transplantation recipients. Bone Marrow Transplant 2001; 28: 657–664.

    Article  PubMed  Google Scholar 

  9. Hassan M, Fasth A, Gerritsen B, Haraldsson A, Syrucková Z, van den Berg H et al. Busulphan kinetics and limited sampling model in children with leukemia and inherited disorders. Bone Marrow Transplant 1996; 18: 843–850.

    CAS  PubMed  Google Scholar 

  10. Bolinger AM, Zangwill AB, Slattery JT, Glidden D, DeSantes K, Heyn L et al. An evaluation of engraftment, toxicity and busulfan concentration in children receiving bone marrow transplantation for leukemia or genetic disease. Bone Marrow Transplant 2000; 25: 925–930.

    Article  CAS  PubMed  Google Scholar 

  11. Slattery JT, Clift RA, Buckner CD, Radich J, Storer B, Bensinger WI et al. Marrow transplantation for chronic myeloid leukemia: the influence of plasma busulfan levels on the outcome of transplantation. Blood 1997; 89: 3055–3060.

    CAS  PubMed  Google Scholar 

  12. Slattery JT, Sanders JE, Buckner CD, Schaffer RL, Lambert KW, Langer FP et al. Graft-rejection and toxicity following bone marrow transplantation in relation to busulfan pharmacokinetics. Bone Marrow Transplant 1995; 16: 31–42.

    CAS  PubMed  Google Scholar 

  13. Vassal G, Hartmann O, Benhamou E . Busulfan and veno-occlussive disease of the liver. Ann Intern Med 1990; 112: 881.

    Article  CAS  PubMed  Google Scholar 

  14. Grochow LB, Jones RJ, Brundrett RB, Braine HG, Chen TL, Saral R et al. Pharmacokinetics of busulfan: correlation with veno-occlusive disease in patients undergoing bone marrow transplantation. Cancer Chemother Pharmacol 1989; 25: 55–61.

    Article  CAS  PubMed  Google Scholar 

  15. Dix SP, Wingard JR, Mullins RE, Jerkunica I, Davidson TG, Gilmore CE et al. Association of busulfan area under the curve with veno-occlusive disease following BMT. Bone Marrow Transplant 1996; 17: 225–230.

    CAS  PubMed  Google Scholar 

  16. Zwaveling J, Bredius RG, Cremers SC, Ball LM, Lankester AC, Teepe-Twiss IM et al. Intravenous busulfan in children prior to stem cell transplantation: study of pharmacokinetics in association with early clinical outcome and toxicity. Bone Marrow Transplant 2005; 35: 17–23.

    Article  CAS  PubMed  Google Scholar 

  17. Jones RJ, Lee KS, Beschorner WE, Vogel VG, Grochow LB, Braine HG et al. Venoocclusive disease of the liver following bone marrow transplantation. Transplantation 1987; 44: 778–783.

    Article  CAS  PubMed  Google Scholar 

  18. Kaplan EL, Meier P . Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457–481.

    Article  Google Scholar 

  19. Mellgren K, Fasth A, Saalman R, Olausson M, Abrahamsson J . Liver transplantation after stem cell transplantation with the same living donor in a monozygotic twin with acute myeloid leukemia. Ann Hematol 2005; 84: 755–757.

    Article  PubMed  Google Scholar 

  20. Reiss U, Cowan M, McMillan A, Horn B . Hepatic venoocclusive disease in blood and bone marrow transplantation in children and young adults: incidence, risk factors, and outcome in a cohort of 241 patients. J Pediatr Hematol Oncol 2002; 24: 746–750.

    Article  PubMed  Google Scholar 

  21. Mc Donald GB, Sharma P, Matthews DE, Shulman HM, Thomas ED . Venocclusive disease of the liver after bone marrow transplantation: diagnosis, incidence, and predisposing factors. Hepatology 1984; 4: 116–122.

    Article  CAS  Google Scholar 

  22. DeLeve LD . Glutathione defense in non-parenchymal cells. Semin Liver Dis 1998; 18: 403–413.

    Article  CAS  PubMed  Google Scholar 

  23. Jenke A, Freiberg-Richter J, Wilhelm S, Freund M, Renner UD, Bornhäuser M et al. Accidental busulfan overdose during conditioning for stem cell transplantation. Bone Marrow Transplant 2005; 35: 125–128.

    Article  CAS  PubMed  Google Scholar 

  24. Petersen FB, Sanders JE, Storb R, Bensinger WI, Clift RA, Buckner CD . Inadvertent administration of a greater-than-usual pre-marrow transplant dose of busulfan—report of a case. Transplantation 1988; 45: 821–822.

    Article  CAS  PubMed  Google Scholar 

  25. Stein J, Davidovitz M, Yaniv I, Ben-Ari J, Gamzu Z, Hoffer E et al. Accidental busulfan overdose: enhanced drug clearance with hemodialysis in a child with Wiskott–Aldrich syndrome. Bone Marrow Transplant 2001; 27: 551–553.

    Article  CAS  PubMed  Google Scholar 

  26. Hassan M, Ljungman P, Ringdén O, Hassan Z, Oberg G, Nilsson C et al. The effect of busulphan on the pharmacokinetics of cyclophoshamide and its 4-hydroxy metabolite: time interval influence on therapeutic efficacy and therapy-related toxicity. Bone Marrow Transplant 2000; 25: 915–924.

    Article  CAS  PubMed  Google Scholar 

  27. Schuler US, Renner UD, Kroschinsky F, Johne C, Jenke A, Naumann R et al. Intravenous busulphan for conditioning before autologous or allogeneic human blood stem cell transplantation. Br J Haematol 2001; 114: 944–950.

    Article  CAS  PubMed  Google Scholar 

  28. Takama H, Tanaka H, Nakashima D, Ueda R, Takaue Y . Population pharmacokinetics of intravenous busulfan in patients undergoing hematopoietic stem cell population. Bone Marrow Transplant 2006; 37: 345–351.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by grants from the Swedish Cancer foundation as well as the Swedish Children Cancer Society.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to K Mellgren.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mellgren, K., Nilsson, C., Fasth, A. et al. Safe administration of oral BU twice daily during conditioning for stem cell transplantation in a paediatric population: a comparative study between the standard 4-dose and a 2-dose regimen. Bone Marrow Transplant 41, 621–625 (2008). https://doi.org/10.1038/sj.bmt.1705947

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1705947

Keywords

This article is cited by

Search

Quick links